The surgical scrub is a standardized procedure for cleansing the hands and forearms to reduce the risk of introducing microorganisms into a patient’s surgical wound. This specialized technique is a fundamental part of aseptic practice, minimizing the incidence of surgical site infections (SSIs). Unlike routine handwashing, which removes transient flora, the surgical scrub aims to significantly reduce the resident microbial population deep within the skin layers. This precise, time-intensive approach ensures the hands and forearms are prepared for the sterile field of the operating room.
Initial Preparation Before Scrubbing
The first step in performing a surgical scrub occurs before the water is turned on, focusing on preparing the hands and forearms for antiseptic treatment. All jewelry, including rings, watches, and bracelets, must be completely removed, as these items harbor microorganisms and interfere with the scrubbing process. Healthcare personnel must inspect their hands and arms for any cuts, abrasions, or broken skin, which could pose a risk of microbial transfer or be irritated by chemical agents. Fingernails should be kept short and free of artificial nails or polish, as these surfaces can shield bacteria from the antiseptic solution.
Once prepared, the individual approaches the scrubbing sink, ensuring supplies like antimicrobial soap and the scrub brush are accessible. The initial wetting process begins by turning on the water, ideally using a foot or knee control to prevent recontamination. Hands and forearms are thoroughly wetted under running water, extending several inches above the elbow. Throughout the procedure, the hands must be held above the elbows, allowing water to flow downward from the fingertips to the elbows by gravity.
The Standardized Scrubbing Technique
Following the initial rinse, the mechanical and chemical cleaning phase begins with applying an antimicrobial agent, typically chlorhexidine gluconate or povidone-iodine. The cleaning process follows one of two standardized methods: the timed method or the counted stroke method. The timed scrub lasts three to five minutes, while the counted stroke method involves applying a specific number of brush strokes (often 10 to 30) to each surface area.
The technique requires using a sterile scrub brush or sponge to generate friction, which aids in removing bacteria. Scrubbing is performed systematically, starting with cleaning beneath the fingernails, often using a small plastic nail pick. The hand and arm are conceptually divided into four planes (dorsal, palmar, and two lateral sides) to ensure every surface receives attention. The scrubbing then proceeds sequentially from the fingertips to the fingers, the hand, and finally the forearm, moving toward the elbow.
The scrubbing motion must be vigorous enough to be effective but gentle enough to avoid abrading the skin, which can encourage bacterial growth. The scrub agent must maintain contact with the skin for the full duration specified by the protocol to allow the antiseptic chemicals to exert their microbial killing effect. Once the scrubbing of the first hand and arm is complete, the brush is discarded, and the entire process is repeated for the second hand and arm.
Rinsing and Maintaining Sterility
The final rinse is a specific action designed to wash the antiseptic agent and dislodged microorganisms from the scrubbed surfaces without recontamination. The hands and forearms are passed through the stream of water, moving from the fingertips to the elbow in one continuous direction. Care must be taken to ensure the water runs off the elbow and that the scrubbed surfaces do not touch the sink basin or any other unsterile surface.
After the rinse, the individual proceeds to the operating room suite, maintaining the hands in an elevated position, well above the waist and away from the body. This posture prevents accidental contact with non-sterile surgical attire or the individual’s body. Drying the hands requires a sterile towel, which is typically found within the sterile gown package.
The towel is grasped, and one end is used to dry one hand completely, moving from the fingertips toward the elbow with a blotting or patting motion. The towel is then flipped to use a fresh, unused section to dry the second hand and forearm. Once dry, the hands are considered sterile and must maintain the elevated, away-from-the-body position until the sterile surgical gown and gloves are donned.